Anticoagulación en terapia de reemplazo renal continua

Abstract

Continuous renal replacement therapies (CRRT) were developed to overcome shortcomings of intermittent haemodialysis in critically ill patients. When CRRT is truly continuous, it provides very effective volume and metabolic control. However, premature loss of extracorporeal circuit patency during CRRT remains a common obstacle and contributes to inadequate treatment, and increased blood loss, costs in nursing time dedicated to CRRT instead of direct patient care. Early loss of circuit patency is related to numerous factors including (a) patient related factors (e.g. critically ill patients with acute kidney injury develop a pro-coagulant state), (b) therapy-related factors (e.g. blood transfusions), and (c) factors related to the CRRT prescription. Thus, strategies implemented to prolong circuit patency must take all these factors into account, particularly those related to CRRT; that is, to optimize the circuit life of the CRRT circuit, one must implement a comprehensive strategy that includes optimization of the catheter, circuit, and CRRT prescription. While optimization of these factors will improve circuit life, anticoagulation is generally also required to maximize it. This can be accomplished via systemic or regional (intra-circuit) anticoagulation strategies. This paper provides an overview of the most commonly used anticoagulation strategies being used in CRRT.